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Evidence to Improve Care

Major of Depression

Care for Adults and Adolescents

Click below to see a list of brief quality statements and scroll down for more information.


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.


Quality Statement 1: Comprehensive Assessment
People suspected to have major depression have timely access to a comprehensive assessment.


Quality Statement 2: Suicide Risk Assessment and Intervention
People with major depression who are at considerable risk to themselves or others, or who show psychotic symptoms, receive immediate access to suicide risk assessment and preventive intervention.


Quality Statement 3: Shared Decision-Making
People with major depression jointly decide with clinicians on the most appropriate treatment for them, based on their values, preferences, and goals for recovery. They have access to a decision aid in a language they understand that provides information on the expected treatment effects, side effects, risks, costs, and anticipated waiting times for treatment options.


Quality Statement 4: Treatment After Initial Diagnosis
People with major depression have timely access to either antidepressant medication or evidence-based psychotherapy, based on their preference. People with severe or persistent depression are offered a combination of both treatments.


Quality Statement 5: Adjunct Therapies and Self-Management
People with major depression are advised about adjunctive therapies and self-management strategies that can complement antidepressant medication or psychotherapy


Quality Statement 6: Monitoring for Treatment Adherence and Response
People with major depression are monitored for the onset of, or an increase in, suicidal thinking following initiation of any treatment. People with major depression have a follow-up appointment with their health care provider at least every 2 weeks for at least 6 weeks or until treatment adherence and response have been achieved. After this, they have a follow-up appointment at least every 4 weeks until they enter remission.


Quality Statement 7: Optimizing, Switching, or Adding Therapies
People with major depression who are prescribed antidepressant medication are monitored for 2 weeks for the onset of effects; after this time, dosage adjustment or switching medications may be considered. People with major depression who do not respond to their antidepressant medication after 8 weeks are offered a different or additional antidepressant, psychotherapy, or a combination of antidepressants and psychotherapy.


Quality Statement 8: Continuation of Antidepressant Medication
People taking antidepressant medication who enter into remission from their first episode of major depression are advised to continue their medication for at least 6 months after remission. People with recurrent episodes of major depression who are taking antidepressant medication and enter into remission are advised to continue their medication for at least 2 years after remission.


Quality Statement 9: Electroconvulsive Therapy
People with severe or treatment-resistant major depression have access to electroconvulsive therapy.


Quality Statement 10: Assessment and Treatment for Recurrent Episodes
People with major depression who have reached full remission but are experiencing symptoms of relapse have timely access to reassessment and treatment.


Quality Statement 11: Education and Support
People with major depression and their families and caregivers are offered education on major depression and information regarding community supports and crisis services.


Quality Statement 12: Transitions in Care
People with major depression who transition from one care provider to another have a documented care plan that is made available to them and their receiving provider within 7 days of the transition, with a specific timeline for follow-up. People with major depression who are discharged from acute care have a scheduled follow-up appointment with a health care provider within 7 days.

4

Treatment After Initial Diagnosis

People with major depression have timely access to either antidepressant medication or evidence-based psychotherapy, based on their preference. People with severe or persistent depression are offered a combination of both treatments.


Both antidepressant medications and evidence-based psychotherapies (such as cognitive behavioural therapy or interpersonal therapy) can be effective treatments for major depression. Combining antidepressants and psychotherapy may be effective for people with severe or treatment-resistant major depression.

For Patients

You should have a choice of psychotherapy or antidepressant drugs. If your depression doesn’t get better, you should be offered a combination of the two treatments.


For Clinicians

Offer people with major depression antidepressants or evidence-based psychotherapy (such as cognitive behavioural therapy or interpersonal psychotherapy). Offer a combination of the two treatments to people with severe or persistent major depression who have tried antidepressants or psychotherapy without an adequate response.


For Health Services

Ensure pharmacotherapy and evidence-based psychotherapies are available and accessible in a timely manner for all people with major depression.

Process Indicator

Percentage of people with severe major depression who receive a combination of medications and psychotherapy within 7 days of their assessment

  • Denominator: total number of people with severe major depression who have been assessed
  • Numerator: number of people in the denominator who receive medications and psychotherapy within 7 days of their assessment
  • Data source: local data collection

Percentage of people with mild to moderate major depression who receive medications or psychotherapy within 4 weeks of their assessment

  • Denominator: total number of people with mild to moderate major depression
  • Numerator: number of people in the denominator who receive medications or psychotherapy within 4 weeks of their assessment
  • Data source: local data collection

Structural Indicator

Availability of evidence-based psychotherapy

  • Data source: local data collection
Timely access
  • For severe depression: within 7 days
  • For mild to moderate depression: within 4 weeks

Evidence-based psychotherapy

This includes cognitive behavioural therapy and interpersonal psychotherapy (see below). Other psychotherapies that may be effective include behavioural activation therapy, short-term dynamic psychotherapy, and mindfulness-based cognitive therapy.


Cognitive behavioural therapy and interpersonal therapy

Cognitive behavioural therapy and interpersonal therapy for major depression should each be:

  • Delivered on a one-to-one or group basis
  • Delivered over 16 to 20 sessions over 3 to 4 months
  • Delivered by an appropriately trained therapist in accordance with a treatment manual

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